The Impact of Family Cohesion and Adaptability on Depressive Symptoms in Adolescents with Depression: A Cross-sectional Study in China

Background Adolescent depression is increasingly prevalent in China, yet studies examining depressive symptoms through the lens of family cohesion and adaptability remain limited. This study explores the association between family cohesion/adaptability and depressive symptoms in adolescents diagnosed with depression, while also assessing the influence of family types on symptom severity, to inform prevention and intervention strategies. Methods Using a stratified cluster sampling approach, we surveyed 540 adolescents with depression across eight provinces in China. Participants completed the Family Adaptability and Cohesion Evaluation Scales II (FACES II) and the Patient Health Questionnaire-9 (PHQ-9). Results Adolescents with greater family cohesion and adaptability displayed reduced depressive symptoms severity and lower recurrence rates (t = 6.982, 2.645; p < 0.05). Total and subscale scores of family cohesion and adaptability showed strong negative correlations with PHQ-9 scores (r = -0.36 to -0.92; p < 0.01). Females, adolescents on "sick leave" academically, and those from families with low cohesion, rigid adaptability, or extreme-type structures reported elevated PHQ-9 scores (p < 0.05). Linear regression analysis confirmed that extreme-type families significantly predicted increased depressive symptom severity (β = 0.26; p < 0.001) after adjusting for demographic factors. Conclusion Family cohesion and adaptability are inversely related to depressive symptoms in adolescents with depression, with family type emerging as a key determinant of symptom severity.